Healthcare Provider Details

I. General information

NPI: 1922589316
Provider Name (Legal Business Name): VENTURE PHYSICAL THERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 ILIMA AVE
LANAI CITY HI
96763
US

IV. Provider business mailing address

101 KANANI RD
KIHEI HI
96753-6805
US

V. Phone/Fax

Practice location:
  • Phone: 808-463-9508
  • Fax: 866-465-8155
Mailing address:
  • Phone: 808-633-4480
  • Fax: 866-465-8155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANN MARIE ANDERSON
Title or Position: OWNER
Credential:
Phone: 808-633-4480